Provider Demographics
NPI:1023693298
Name:AMG OF WASHINGTON, PC
Entity type:Organization
Organization Name:AMG OF WASHINGTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-506-1858
Mailing Address - Street 1:4045 E BELL RD STE 157
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2240
Mailing Address - Country:US
Mailing Address - Phone:602-404-0015
Mailing Address - Fax:
Practice Address - Street 1:302 E 37TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-2212
Practice Address - Country:US
Practice Address - Phone:888-506-1858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty